Purpose: For more than a decade, transcatheter aortic valve implantation (TAVI) has become a promising treatment modality for patients with severe aortic stenosis. As the procedure enlarges from high-risk to lower-risk patients, the amount of patients in cardiac rehabilitation (CR) is rapidly growing. Up to now, there are no sufficient data about frailty and its possible predictive value of mortality. Therefore, we aimed to evaluate pre-interventional predictors for all-cause mortality in patients after TAVI with a 12-month follow up.
Methods: From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in the prospective multicentre cohort study, whereby 333 patients (80.1 ± 5.1 years, 44.1 % male) survived the procedure. Pre-interventionally, we documented sociodemographic, laboratory and echocardiographic parameters as well as comorbidities. Additionally, function by 6-minute walk test, quality of life by SF-12 and a Frailty Index (a score consisting of Activities of Daily Living, Instrumental Activities of Daily Living, Mini Mental State Exam [MMSE], Mini Nutritional Assessment [MNA], Timed Up and Go, and a subjective pre-clinical mobility disability) were performed. Predictors for all-cause mortality were identified using a multivariate regression model.
Results: During a follow up of 381.0 ± 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 ± 5.0 vs. 80.6 ± 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 ± 1.4 vs. 2.1 ± 1.3; p = 0.026) as well as a lower left ventricular ejection fraction (51.0 ± 13.6 vs. 54.6 ± 10.6; p = 0.048) and additionally, more of the non-survivors suffered from diabetes mellitus (60.9 % vs. 44.6 %; p = 0.040). The Frailty-Index does not seem to be a predictor for all-cause mortality itself, but its single components such as MNA (OR 0.69, CI 0.70 - 0.95; p = 0.009) and MMSE (OR 0.77, CI 0.76 - 0.99; p = 0.030) show a predictive value. Furthermore, the physical component scale of SF-12 (OR = 0.90, CI 0.90 - 1.00; p = 0.031) as well as clinical parameters such as diabetes mellitus (OR 1.11, CI 1.11 - 5.29; p = 0.026) and EuroScore (OR 1.01, CI 1.01 - 1.08; p = 0.006) could be identified as predictors.
Conclusions: The results of the underlying analysis provide information about pre-interventional parameters being predictive for one-year all-cause mortality in patients after TAVI. Frailty as a whole still seems to be difficult to capture. Thus, beside clinical parameters and quality of life, single dimensions of frailty, such as cognitive function and nutrition status, should be considered in the decision of possible therapies and aftercare programs in high-risk patients with severe aortic stenosis.